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Prime Minister Prayut’s Reforms “Could End Universal Healthcare in Thailand”




BANGKOK –  Prime Minister Prayut Chan-o-cha Military installed government the National Council for Peace and Order (NCPO) hostility towards universal health coverage is planning reforms that could weaken the health security of Thai citizens, health experts warn.

Though there has been no drastic change to the health system under four years of National Council for Peace and Order (NCPO) rule, experts worry that universal coverage is set to be degraded to cover the poorest members of society only.

The junta’s hostile attitude was only part of the problem, academics and activists said. The health security of Thais was also threatened by the huge disparity between the three main health security schemes, while urgent action was needed to secure the sustainability of the current system.

Nimit Tien-udom, a rights defender from the People’s Health System Movement, said Thailand’s globally renowned public health system is under major threat from the NCPO’s reform plans. It was the public’s duty to protect this fine policy, he added.

“Our health security, especially the Universal Health Coverage (UC) scheme, is a highly beneficial system that stops people from going bankrupt through health expenses while allowing all citizens access to adequate and affordable healthcare,” Nimit said.

“However, as this regime has a military-bureaucratic background, they hold a hostile view of the system, especially the UC scheme which they see as a drain on the national budget. So they seek to weaken it.”

He revealed that the government was trying to amend the National Health Security Office (NHSO) Act and draft a bill to establish a National Health Policy Board. These reforms to healthcare would lead to more centralization that would reduce public sector participation in health policy planning.



Prime Minister General Prayut has repeatedly said his government has no intention of revoking universal healthcare, but added that reform was needed to curb the increasing expense of the system.

Budget reform plans include restricting universal healthcare to the 14 million citizens registered as poor, and enforcing co-payment by patients.

Nimit cautioned that these changes would destroy the original intention to provide access to proper healthcare for all citizens and turn the system into humanitarian health assistance for the poorest 14 million, while in reality more than 48 million people currently depend on the UC scheme.

While co-payment was not an entirely bad idea, he added, patients should not be made to pay for care after getting sick, since this could cause them sudden financial crisis.

This year, the NHSO has received a Bt111.179-billion budget for the UC scheme, or Bt3,197 for each beneficiary. The Cabinet has approved next year’s budget of Bt166.445 billion, or Bt3,426 per head.

Ammar Siamwalla, senior health security researcher at the Thailand Development Research Institute, said reform was necessary to ensure the sustainability of the system.

However, Ammar said reform needed to prioritize lowering the disparity between our three main health schemes and ensure that all citizens, especially the middle class, benefit from the system.

If the government restricts health security only to the poor, the expense and quality of healthcare would be kept to the minimum, he said. But if all citizens, including the politically active middle class, were covered, they could play a powerful role in campaigning for the system’s improvement and ensuring good and affordable healthcare for all.

By Pratch Rujivanarom
The Nation


Initiated by the Thaksin Shinawatra government in 2001, the scheme was first known as the 30-baht health scheme – so-called because those who could afford it paid a flat 30 baht per consultation – and ostensibly opened access to medical treatment for all.

It was developed by a rural doctor Sa-nguan Nittayarampong, who convinced the Thaksin administration to pilot and fund the programme in 2001, despite objections from the previous government because the economy was still recovering after the 1997 financial crisis.

UC covers healthcare for more than 48 million Thais. The NHSO’s executive board makes decisions on how to run the UC scheme. The board consists of representatives of patients and civil society, government agencies, hospital operators and professional doctors.

For years, rural doctors have pushed the idea of universal health coverage, but it did not gain traction until Thaksin came to power. It became one of his major policies that won grassroots support across the country.

Patients paid only 30 baht for medical services at state hospitals. The NHSO was established using the government Budget to fund medical fees.

After the 2006 Military coup, the 30-baht healthcare was revoked. The scheme was renamed “gold card” or UC by the interim government.

The renaming of the universal scheme was seen as an attempt to eliminate the image of Thaksin as icon of the scheme.

Resistance to UC comes from many players, including state administrators who could not exercise power over the NHSO board, civil servants who lost their hold on health funding, and doctors whose status is threatened by the emerging voice of patients.

After Prime Minister Prayut Chan-o-cha 2014 Military coup, the threat against healthcare have gone up…… Read Full Story…

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